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Medicina Intensiva 2015
Review
Topics: Acute Kidney Injury; Central Venous Catheters; Comorbidity; Echocardiography, Transesophageal; Electric Countershock; Heart Arrest; Heart Atria; Heart Diseases; Humans; Influenza, Human; Male; Middle Aged; Renal Dialysis; Tachycardia, Supraventricular; Thrombosis; Tricuspid Valve
PubMed: 25443329
DOI: 10.1016/j.medin.2014.08.001 -
Journal of Thrombosis and Thrombolysis Jan 2021Studies using whole blood platelet aggregometry as a laboratory research tool, provided important insights into the mechanism and modulators of platelet aggregation.... (Review)
Review
Studies using whole blood platelet aggregometry as a laboratory research tool, provided important insights into the mechanism and modulators of platelet aggregation. Subsequently, a number of point-of-care (POC) platelet function tests (PFTs) were developed for clinical use, based on the concept that an individual's thrombotic profile could be assessed in vitro by assessing the response to stimulation of platelet aggregation by specific, usually solo agonists such as adenosine diphosphate (ADP), collagen and thrombin. However, adjusting antiplatelet medication in order to improve the results of such POC PFTs has not translated into a meaningful reduction in cardiovascular events, which may be attributable to important differences between the POC PFT techniques and in vivo conditions, including patient-to-patient variability. Important limitations of most tests include the use of citrate-anticoagulated blood. Citrate directly and irreversibly diminishes platelet function and even after recalcification, it may result in altered platelet aggregation in response to ADP, epinephrine or collagen, and interfere with thrombin generation from activated platelets. Furthermore, most tests do not employ flowing blood and therefore do not assess the effect of high shear forces on platelets that initiate, propagate and stabilize arterial thrombi. Finally, the effect of endogenous thrombolysis, due to fibrinolysis and dislodgement, which ultimately determines the outcome of a thrombotic stimulus, is mostly not assessed. In order to accurately reflect an individual's predisposition to arterial thrombosis, future tests of thrombotic status which overcome these limitations should be used, to improve cardiovascular risk prediction and to guide pharmacotherapy.
Topics: Animals; Blood Coagulation; Blood Platelets; Heart Atria; Humans; Platelet Aggregation; Platelet Function Tests; Point-of-Care Testing; Thrombosis
PubMed: 32529549
DOI: 10.1007/s11239-020-02170-z -
Chinese Medical Journal Jan 2018
Topics: Heart Atria; Humans; Rupture, Spontaneous; Thrombosis
PubMed: 29336375
DOI: 10.4103/0366-6999.222329 -
Balkan Medical Journal Apr 2020
Topics: Aged, 80 and over; Dyspnea; Echocardiography, Transesophageal; Female; Heart Atria; Humans; Thrombosis
PubMed: 31893583
DOI: 10.4274/balkanmedj.galenos.2019.2019.11.79 -
JACC. Clinical Electrophysiology Apr 2020This study aimed to investigate the feasibility and safety of left atrial appendage occlusion (LAAO) procedures in patients with persistent left atrial appendage (LAA)...
OBJECTIVES
This study aimed to investigate the feasibility and safety of left atrial appendage occlusion (LAAO) procedures in patients with persistent left atrial appendage (LAA) thrombus.
BACKGROUND
The left atrial appendage (LAA) is the most common site of thrombus formation in patients with nonvalvular atrial fibrillation (AF). Oral anticoagulation (OAC) is used to prevent and treat AF-related thrombus. However, a significant proportion of patients may not be eligible for long-term OAC therapy. In many cases, OAC may fail to resolve the thrombus. Left atrial appendage occlusion (LAAO) may be a potential option in such cases. Major LAAO studies have excluded patients with LAA thrombus, and it is not known whether LAAO procedures in the presence of LAA thrombus is feasible and safe.
METHODS
This was a systematic review of patient-level data of all published cases of LAAO in the presence of LAA thrombus.
RESULTS
There was a total of 58 patients included in the study. Most of the patients had a distally located thrombus in the LAA. All cases underwent successful implantation of LAAO devices with some procedural modifications. Amulet was the most commonly used device (50%). A cerebral protection device was used in 17 (29%) patients, and procedural transesophageal echocardiography was used in most of the cases. One stroke (1.7%) and 2 (3.4%) device-related thromboses were noted during the mean follow-up of 3.4 ± 7 months.
CONCLUSIONS
Percutaneous LAAO procedures appear to be feasible in patients with a distally located persistent LAA thrombus when performed by experienced operators with some technical modifications. Further studies are required to determine the long-term safety and efficacy of this approach.
Topics: Atrial Appendage; Atrial Fibrillation; Feasibility Studies; Humans; Thrombosis; Treatment Outcome
PubMed: 32327075
DOI: 10.1016/j.jacep.2019.11.017 -
BMJ Case Reports Dec 2020A 49-year-old man with a recent history of atrial tachycardia and intracardiac thrombus presented to the emergency department with melena and cardiac tamponade. Physical...
A 49-year-old man with a recent history of atrial tachycardia and intracardiac thrombus presented to the emergency department with melena and cardiac tamponade. Physical examination was notable for a vascular mass at the right lower gingival sulcus and a right chest wall nodule. Enteroscopy revealed a target lesion with friable ulcer in the gastric body. Cardiac MRI revealed a large right atrial mass, previously thought to represent thrombus. The patient was ultimately diagnosed with primary cardiac angiosarcoma (PCAS) by histopathology of gingival, gastric and subcutaneous lesions. This case illustrates the significant morbidity and mortality resulting from aggressive local invasion and growth of PCAS, as well as the challenge of differentiating between primary thrombosis and vascular malignancy. Misdiagnosis of this elusive clinical entity may be costly, potentially resulting in delay of intervention and adverse effects of alternate therapies such as anticoagulation.
Topics: Cardiac Tamponade; Diagnosis, Differential; Fatal Outcome; Heart Atria; Heart Neoplasms; Hemangiosarcoma; Humans; Male; Melena; Middle Aged; Pericardial Effusion; Venous Thrombosis
PubMed: 33298483
DOI: 10.1136/bcr-2020-236806 -
Journal of Medicine and Life Nov 2011Nonvalvular atrial fibrillation is the most common sustained arrhythmia in adults, and it is described as a relationship between it and right atrium thrombosis. A case... (Review)
Review
Nonvalvular atrial fibrillation is the most common sustained arrhythmia in adults, and it is described as a relationship between it and right atrium thrombosis. A case of a 76-year-old man who presented with severe recent-onset dyspnea and several co-morbidities, such as permanent atrial fibrillation, with no anticoagulant therapy is reported here. Echocardiography showed a massive thrombus in right atrium, without any clinical or echographic signs of peripheral veins thrombosis. This article is also a review of the cases from literature.
Topics: Aged; Atrial Fibrillation; Echocardiography; Heart Atria; Humans; Male; Thrombosis
PubMed: 22514566
DOI: No ID Found -
Medicine Jun 2018To evaluate the anticoagulation efficacy of dabigatran etexilate for left atrial appendage (LAA) thrombus resolution in patients with atrial fibrillation by... (Comparative Study)
Comparative Study Observational Study
Anticoagulation efficacy of dabigatran etexilate for left atrial appendage thrombus in patients with atrial fibrillation by transthoracic and transesophageal echocardiography.
To evaluate the anticoagulation efficacy of dabigatran etexilate for left atrial appendage (LAA) thrombus resolution in patients with atrial fibrillation by transthoracic echocardiography and transesophageal echocardiography, and to investigate the anticoagulation factors.A total of 58 atrial fibrillation patients with LAA thrombus in our hospital were enrolled. After dabigatran etexilate anticoagulation for 3 months, the patients were divided into the effective group and ineffective group according to dissolution of thrombosis. The baseline data and the left atrial diameter (LAD), left atrial ejection fraction (LAEF), left ventricular ejection fraction, LAA flow velocity (LAA-v), and LAA thrombus size before and after anticoagulation treatment were recorded, and the measurement index were statistically analyzed.After the patients received anticoagulation treatment for 3 months, 15 patients had complete dissolution, thrombus in 21 patients reduced significantly, and the complete dissolution rate was 25.9% (15/58), the effective rate of dissolution was 62.1% (36/58). Compared with the ineffective group, the proportion of persistent atrial fibrillation and LAD in effective group were lower than those in the ineffective group, the LAEF and LAA-v in the effective group were higher than those in the ineffective group, and the differences were statistically significant (P < .05). Multivariate logistic regression analysis on the baseline data and each ultrasound index showed that the type of atrial fibrillation, LAD, LAEF, and LAA-v were independently associated with the efficacy of anticoagulation (P < .05).Dabigatran etexilate is effective in dissolution of LAA thrombus in patients with atrial fibrillation, and the atrial fibrillation type, LAD, LAEF, and LAA-v are significantly related with the efficacy of anticoagulation.
Topics: Aged; Antithrombins; Atrial Appendage; Atrial Fibrillation; Blood Flow Velocity; Dabigatran; Echocardiography; Echocardiography, Transesophageal; Female; Heart Atria; Humans; Male; Middle Aged; Stroke Volume; Thrombosis; Treatment Outcome; Ventricular Function, Left
PubMed: 29952953
DOI: 10.1097/MD.0000000000011117 -
Journal of the American College of... Feb 1994The management of anticoagulant therapy in patients with atrial fibrillation undergoing electrical cardioversion remains controversial, largely because of inadequate... (Review)
Review
The management of anticoagulant therapy in patients with atrial fibrillation undergoing electrical cardioversion remains controversial, largely because of inadequate studies demonstrating risk or benefit, a relatively inconvenient anticoagulation management strategy and the increasing use of transesophageal echocardiography. Recent investigations into the potential mechanisms involved in the development of thrombus and systemic embolism in patients undergoing electrical cardioversion of atrial fibrillation may provide insight into underlying predisposing factors, with subsequent modification of management strategies. Conventional wisdom suggests that preexisting thrombus is responsible for thromboembolic events after cardioversion. However, development of a thrombogenic milieu after cardioversion, particularly in the left atrial appendage, may also be an important predisposing factor. To protect against both potential mechanisms of embolization, these data support therapeutic anticoagulation for all patients with atrial fibrillation of > 2 days in duration from the time of, as well as after cardioversion for a total of 4 weeks, undergoing cardioversion, even in the absence of thrombus on echocardiography. Therefore, the role of transesophageal echocardiography in this setting should be to enable early cardioversion if atrial thrombus is excluded and to identify high risk patients with atrial thrombi so as to postpone cardioversion and avoid the risk of embolization. Ultimately, however, a controlled, randomized and prospective clinical trial will be required to compare conventional management with a transesophageal echocardiography-guided strategy.
Topics: Anticoagulants; Atrial Fibrillation; Echocardiography, Transesophageal; Electric Countershock; Embolism; Heart Atria; Heart Diseases; Humans; Thrombosis
PubMed: 8294710
DOI: 10.1016/0735-1097(94)90443-x -
International Journal of Molecular... Jun 2022A 72-year-old female patient with mixed rheumatic mitral valve disease and persistent atrial fibrillation underwent mitral valve replacement and suffered from a combined...
A 72-year-old female patient with mixed rheumatic mitral valve disease and persistent atrial fibrillation underwent mitral valve replacement and suffered from a combined thrombosis of the bioprosthetic valve and the left atrium as soon as 2 days post operation. The patient immediately underwent repeated valve replacement and left atrial thrombectomy. Yet, four days later the patient died due to the recurrent prosthetic valve and left atrial thrombosis which both resulted in an extremely low cardiac output. In this patient's case, the thrombosis was notable for the resistance to anticoagulant therapy as well as for aggressive neutrophil infiltration and release of neutrophil extracellular traps (NETs) within the clot, as demonstrated by immunostaining. The reasons behind these phenomena remained unclear, as no signs of sepsis or contamination of the BHV were documented, although the patient was diagnosed with inherited thrombophilia that could impede the fibrinolysis. The described case highlights the hazard of immunothrombosis upon valve replacement and elucidates its mechanisms in this surgical setting.
Topics: Aged; Female; Heart Atria; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Thromboinflammation; Thrombosis
PubMed: 35743174
DOI: 10.3390/ijms23126736